Healthcare Provider Details

I. General information

NPI: 1124888714
Provider Name (Legal Business Name): NICOLE RYLIE MORINE MS, LPC, NCC, CYMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31600 TELEGRAPH RD STE 230
BINGHAM FARMS MI
48025-4372
US

IV. Provider business mailing address

31600 TELEGRAPH RD STE 230
BINGHAM FARMS MI
48025-4372
US

V. Phone/Fax

Practice location:
  • Phone: 248-723-9200
  • Fax: 248-723-9218
Mailing address:
  • Phone: 248-723-9200
  • Fax: 248-723-9218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401018570
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401018570
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401018570
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: